RNY to BPD
I had the RNY in 2003, and gained 80 of the 120 lbs lost. I thought I wanted a DS; as I have been trying to research the options. I just spoke with Dr. Olsen in Nashville (via phone) who said I needed to go to BPD without the switch. He said the malabsorbption part of the surgeries are the same, with 100 cm common channel. So it seems you are left with dumping, and a blind pouch. I have read that the DS works because of the synergistic attributes of the sleeve and short common channel. Im not sure what makes it work together, aside from the obvious restriction, and I am a little confused about the 12-18 mo "window". Anyone have any experience with this type of surgery? I am wondering if it is also called a distal RNY or ERNY. Not real sure about that.
Amy Farrah Fowler
on 1/6/09 11:27 am
on 1/6/09 11:27 am
The BPD is a horrible, outdated surgery, that is going away for good reason. I can't fathom any reason a surgeon would recommend it, other than the fact they aren't able to do a DS, much less a revision to a DS (Dr. Olsen is in that category).
It has all the negatives of both surgeries, without the benefits of the DS. You might want to ask this on the DS board, as there are a few who are very familiar with that procedure, and can articulate the differences better. I would run from any surgeon that wants to do a BPD, or a ERNY.
It has all the negatives of both surgeries, without the benefits of the DS. You might want to ask this on the DS board, as there are a few who are very familiar with that procedure, and can articulate the differences better. I would run from any surgeon that wants to do a BPD, or a ERNY.
Two answers to this: NO and HELL NO!!
I wouldn't speak to this guy any further. The BPD is a WORTHLESS surgery, a last resort for a very few miserable medical conditions -- it has a pretty lousy track record with long term complications and malnutrition. And it is NOT an ERNY -- in the BPD, the distal part of the stomach, the pyloric valve and the duodenum are REMOVED -- GONE, irreversibly. No chance of ever fixing it again. No blind pouch -- they remove it. I think a blind pouch is a horrible construction -- but at least it provides the opportunity to FIX it back to a VSG and a proper DS!
I have spent the last 5 years trying to convince the DS surgeons to stop using the term "BPD/DS" to describe the DS, because the insurance companies use the confusion to cite BPD poor outcomes as reasons to not cover the DS. DO NOT GO THERE!
I wouldn't speak to this guy any further. The BPD is a WORTHLESS surgery, a last resort for a very few miserable medical conditions -- it has a pretty lousy track record with long term complications and malnutrition. And it is NOT an ERNY -- in the BPD, the distal part of the stomach, the pyloric valve and the duodenum are REMOVED -- GONE, irreversibly. No chance of ever fixing it again. No blind pouch -- they remove it. I think a blind pouch is a horrible construction -- but at least it provides the opportunity to FIX it back to a VSG and a proper DS!
I have spent the last 5 years trying to convince the DS surgeons to stop using the term "BPD/DS" to describe the DS, because the insurance companies use the confusion to cite BPD poor outcomes as reasons to not cover the DS. DO NOT GO THERE!
Run, don't walk, to the nearest exit. You do NOT want a BPD surgery!
Please visit either www.dsfacts.com or www.duodenalswitch.com to see list of reputable DS surgeons. And not even all of them can do revisions--that's very specialized, complicated surgery. (Your pyloric valve could have atrophied from disuse, you may have lots of adhesions, etc.)
As to your questions about the DS mechanics. Think about it this way, you have restriction (reduced stomach) and malabsorption (intestines) working together. You eat less and what you eat is absorbed differently (less) than ever before. PLUS, the way the DS stomach is cut, it's along the greater curvature instead of just across like in the RNY, which reduces the hormone grehlin, which affects how "hungry" you think you are.
ALSO, the DS keeps your anatomy working as it is supposed to, with a pyloric valve to regulate food, so no real dumping.
Some people dispute that there is actually a true "weight loss window" with a DS. We have a couple examples of people who can lose even 5-8 years out from their DS. The "window" idea is that your restriction lessens a bit over time as you stomach stretches a bit and the intestines adapt to absorb more over time. Still, it seems to be easier to lose more weight upfront, straight out of the gate, so most people (including me) want to do it as quickly as they can.
I hope this info helps.
Nicolle
Please visit either www.dsfacts.com or www.duodenalswitch.com to see list of reputable DS surgeons. And not even all of them can do revisions--that's very specialized, complicated surgery. (Your pyloric valve could have atrophied from disuse, you may have lots of adhesions, etc.)
As to your questions about the DS mechanics. Think about it this way, you have restriction (reduced stomach) and malabsorption (intestines) working together. You eat less and what you eat is absorbed differently (less) than ever before. PLUS, the way the DS stomach is cut, it's along the greater curvature instead of just across like in the RNY, which reduces the hormone grehlin, which affects how "hungry" you think you are.
ALSO, the DS keeps your anatomy working as it is supposed to, with a pyloric valve to regulate food, so no real dumping.
Some people dispute that there is actually a true "weight loss window" with a DS. We have a couple examples of people who can lose even 5-8 years out from their DS. The "window" idea is that your restriction lessens a bit over time as you stomach stretches a bit and the intestines adapt to absorb more over time. Still, it seems to be easier to lose more weight upfront, straight out of the gate, so most people (including me) want to do it as quickly as they can.
I hope this info helps.
Nicolle
I had the kick-butt duodenal switch (DS)!
HW: 344 lbs CW: 150 lbs
Type 2 diabetes and sleep apnea GONE!
The BPD is is outdated that I didn't think anyone in the USA was still doing it. The DS was created to have the excellent weight loss results of the BPD but without the bad problems of nutritional deficiencies and diarrhea. Yes, the malabsorption parts are the same, but the DS has the sleeve gastrectomy, which is essentially a normal but smaller stomach, whereas the BPD has the lower half (or so) of the stomach cut out, thus removing the pyloric valve, and the remaining stomach is attached to the small intestine. It caused too high a rate of problems. That's why "no one" does it anymore (except for this guy that the people from the DS forum have never heard of).
Please come over to the Ds forum and learn more about a modern operation that does not have a blind pouch, does not have dumping, and has a very low incidence of nutritional problems. The Ds is also not at all the same as the distal RNY or ERNY, which keep the same old pouch that you already have (and whatever issues you have with it) and just gives you more malabsorption. I think you have some more research to do, and there are many well informed people on the DS forum who can help you.
Larra
Please come over to the Ds forum and learn more about a modern operation that does not have a blind pouch, does not have dumping, and has a very low incidence of nutritional problems. The Ds is also not at all the same as the distal RNY or ERNY, which keep the same old pouch that you already have (and whatever issues you have with it) and just gives you more malabsorption. I think you have some more research to do, and there are many well informed people on the DS forum who can help you.
Larra
Thanks to everyone! I appreciate the info; sometimes it is just so hard to wrap my mind around it all. I have looked at the mentioned sites, and have found a lot of info about the DS and RNY, but not too much from RNY to DS. It finally dawned on me that I think they sort of start over; putting things back then creating the sleeve and switch. One of the best things I read was that with the stomach in normal order, (not a pouch), it is ok to drink while eating; this can help fill you up if you are eating too much. I have always felt like I was choking with the RNY, not being able to drink while eating.
I have an appt with Dr. Husted in the morning; and just want the best info. I will be sure to post how it turns out!
Thanks again
Jamie
Jamie,
I had a revision to DS from my 1980 gastric bypass stomach stapleing on Sept. 17. The old surgery was basically an old RNY except that the blind stomach was not seperated, it was just stapled off. What you had learned in that the RNY is taken apart and everything is put back together is correct, this is why it's so improtant to get a very good DS surgeon to do your revision and also why there are so many surgeons that will try and talk you out of a DS. It's a difficult operation to perform and can be very time consuming; mine took 8 1/2 hours and then a second 4 1/2 hour surgery three days later.
Dr. Husted is one of the best, you're doing the right thing. I would also suggest you check in over on the DS board, I think you will enjoy the people there and also learn a ton.
Best regards,
Kerry
I had a revision to DS from my 1980 gastric bypass stomach stapleing on Sept. 17. The old surgery was basically an old RNY except that the blind stomach was not seperated, it was just stapled off. What you had learned in that the RNY is taken apart and everything is put back together is correct, this is why it's so improtant to get a very good DS surgeon to do your revision and also why there are so many surgeons that will try and talk you out of a DS. It's a difficult operation to perform and can be very time consuming; mine took 8 1/2 hours and then a second 4 1/2 hour surgery three days later.
Dr. Husted is one of the best, you're doing the right thing. I would also suggest you check in over on the DS board, I think you will enjoy the people there and also learn a ton.
Best regards,
Kerry
Most Active
Recent Topics
